La Jolla Figure Skating Club 2013

La Jolla Figure Skating Club
2013-2014 Membership Instructions
Dear Prospective La Jolla FSC Member,
Thank you for your interest in joining the La Jolla Figure Skating Club. Both the La Jolla FSC and US Figure Skating membership
periods run from July 1st through June 30th each year. By joining the La Jolla FSC, you also become a member of US Figure Skating.
As a La Jolla FSC member you are welcome to participate in the many activities that are planned throughout the year. Past activities
have included Holiday Shows, pool parties, beach parties, swap meets, and our annual La Jolla Open competition. Membership
applications/renewals are processed once a month, but can be expedited for a fee. Please follow the instructions below to become
a member.
Membership instructions:
1.
Please fill out the 2013-2014 Membership Application Form completely. One form per member. You can also obtain
additional copies of the form from the Club's website at www.lajollafsc.com.
2.
Read, sign and return the two page Waiver and Parental Consent Agreement. This form must be returned with your
application before your membership will be processed.
3.
Please read, sign and return the optional Photo Waiver Form.
4.
Please include an email address on your form. The Club uses email as the primary method of communication to our
members. The first email address provided must be that of the minor skater's parent or legal guardian. You may include
a second email address if you want both skater and parent/guardian to receive Club emails.
5.
Check only one option in the Membership Fees chart.
6.
Introductory Member - Can be used only once for first time US Figure Skating membership.
7.
Collegiate Member - Must provide proof of current college enrollment or acceptance for 2013-2014 school year.
8.
Late Fees: $10.00 for all membership renewal forms received after June 30th.
9.
Expedited Processing Fee: $25.00 processing fee for any membership forms (new or renewal) that need to be expedited.
th
• After June 30 , a total of $35.00 will be assessed (late fee plus expedition) on expedited membership renewals.
10.
We appreciate any and all donations to the Club. We are a non-profit 501(c)(3) organization. Make checks payable to La
Jolla Figure Skating Club. Please mail forms and payment to:
Membership Chair
La Jolla Figure Skating Club
P.O. Box 928243
San Diego, CA 92192
[email protected]
Please note: You must be a member of US Figure Skating to Test or Compete.
Again, thank you for your interest in becoming a member of the La Jolla Figure Skating Club. We are looking forward to another
exciting year of skating.
Membership Chair
La Jolla Figure Skating Club
2013-2014 Membership Application Form
Name:
For the year July 1, 2013 through June 30, 2014
Personal Information
□ New Member □ Renewing Member
US Figure Skating #:
Date of Birth (REQUIRED):
Address:
City:
State:
Mo:
Zip Code:
Day:
□ Female
Yr:
□
Male
U.S . Citizen (REQUIRED):
1st Email Address (Parent of Legal Guardian):
□ Yes
Home Phone:
Cell Phone:
Parent's/Guardian's Name(s) if member is under 18 years of age:
Phone # (if different than above):
□ No
2nd Email Address:
Membership Fees (Check only One)
Skating Member
(new to La Jolla FSC and renewing
US Figure Skating members)
Additional Skating Member
in same household (i.e. sibling)
Coach/Patron Member
Tax Deductible Voluntary Donations
$95.00
□
$60.00
□
□
$150.00 □
$70.00
Collegiate Member (4 year membership,
may only use 1 time)
Introductory Member First time U.S. Figure Skating Members ONLY
US Figure Skating OfficialsJudges, Tech Panel, Accountants
Parent/Guardian of LJFSC Member
residing at same address
Non-Home Club Member
List Home Club:_____________________
$65.00
□
$30.00
□
$30.00
□
$40.00
□
Competitor's Fund (grants are given to qualified
competitors)
Club Functions (helps cover costs of test sessions,
shows and other events)
Educational Fund (helps cover costs of seminars &
schools)
Total Donation:
Membership Fee (from left):
Late Fee (after June 30th) - $10.00:
Renewing memberships only
Expedited Processing Fee - $25.00:
New or renewing memberships
Total Amount Enclosed:
$______________
$______________
$_______________
$ 0.00
$_______________
$ 0.00
$_______________
$________________
$ _______________
$ 0.00
$_______________
Mail & make check payable to:
La Jolla Figure Skating Club,
P.O. Box 928243, San Diego, CA 92192
All memberships, except Non-Home, receive membership in U.S. Figure Skating, Skating Magazine (one per address), and is a voting member. All
memberships receive La Jolla FSC activity notices.
AGREEMENT - All information on this form is true and correct. As a member or parent/guardian thereof, I/we fully understand the hazards
associated with ice skating facilities and do hereby absolve the La Jolla Figure skating Club from any liability or claims for injuries or damages that
may occur to me/us at events or practices sponsored by the La Jolla Figure Skating Club. I understand that any/all of this information may be
printed in a club roster to be distributed to all members of the La Jolla Figure Skating Club.
Member Signature: __________________________________________________________________________ Date: _______________________
Patent/Legal Guardian's Signature (if member is a minor): ___________________________________________ Date: _______________________
Club Use Only
Date Received:
Check Number:
Amount:
La Jolla Figure Skating Club Photography Waiver:
I, ___________________________, am the lawful parent or guardian of __________________________,
presently a member of the La Jolla Figure Skating Club and a minor. By signing below, I am granting
permission for my child to be photographed and/or recorded in connection with any and all figure skating
activities. I understand the photographs and/or media productions in which my child may be a participant may
be used for purposes including but not limited to the La Jolla Figure Skating Club website, UTC Ice display
boards and other La Jolla Figure Skating Club marketing/promotional programs.
____________________________________________
_____________________
Parent/Legal Guardian Signature
Date
La Jolla Figure Skating Club Photography Waiver:
I, ___________________________, am the lawful parent or guardian of __________________________,
presently a member of the La Jolla Figure Skating Club and a minor. By signing below, I am granting
permission for my child to be photographed and/or recorded in connection with any and all figure skating
activities. I understand the photographs and/or media productions in which my child may be a participant may
be used for purposes including but not limited to the La Jolla Figure Skating Club website, UTC Ice display
boards and other La Jolla Figure Skating Club marketing/promotional programs.
____________________________________________
Parent/Legal Guardian Signature
_____________________
Date